The Upper Hand: Chuck & Chris Talk Hand Surgery
May 24, 2026 · 46 min · 14 segments
Chuck and Chris continue the initiative working with The Journal of Hand Surgery on a quarterly journal club. Nash and Macerena choose the articles from the previous quarter and Chris and Chuck…
Uh, she has, um, [lips smack] isolated, uh, right upper extremity complaints, and really her complaints are night awakenings, numbness in the thumb, index, and middle finger, uh, some electrical sensations.
I needed a straightforward, uh, carpal tunnel today." So after talking to her and making up my mind that I know what she has, um, I did the exam [laughs].
Um, she had negative cervical signs, negative cubital tunnel signs, but she has a very hot pronator irritated nerve.
And, you know, I, I tried the elbow extended, um, resisted pronation test to see if, uh, that made it worse.
Number one, in the first scenario, do you still get nerve studies? Meaning if it's just carpal tunnel and clicks, you know, checks all the boxes, CTS 6 is clearly positive, do you still get nerve studies? And does-- would this presentation potentially, uh, change or de- definitely lead you to nerve studies to assess the pronator?
The first question I have is, does this patient have a muscular forearm? So like I've found in laborer-type people or just really muscular people, the forearm becomes a more common source of compression.
Uh, she has, um, [lips smack] isolated, uh, right upper extremity complaints, and really her complaints are night awakenings, numbness in the thumb, index, and middle finger, uh, some electrical sensations.
I needed a straightforward, uh, carpal tunnel today." So after talking to her and making up my mind that I know what she has, um, I did the exam [laughs].
Um, she had negative cervical signs, negative cubital tunnel signs, but she has a very hot pronator irritated nerve.
And, you know, I, I tried the elbow extended, um, resisted pronation test to see if, uh, that made it worse.
Number one, in the first scenario, do you still get nerve studies? Meaning if it's just carpal tunnel and clicks, you know, checks all the boxes, CTS 6 is clearly positive, do you still get nerve studies? And does-- would this presentation potentially, uh, change or de- definitely lead you to nerve studies to assess the pronator?
The first question I have is, does this patient have a muscular forearm? So like I've found in laborer-type people or just really muscular people, the forearm becomes a more common source of compression.
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